Setting limits : medical goals in an aging society /

A cogent, easy-to-read, thoroughly thought through and documented examination of current attitudes and behaviors toward the aging in the US. Callahan, director of The Hastings Center, a preeminent American think tank on ethical issues, urges, first, movement away from use of all technologies for life extension and toward attention to the quality of life of the elderly. He also supports a concept of a natural life span beyond which heroic life-sustaining measures will not be taken, and the cessation of efforts to postpone death, accepting it as a condition of life. All sides of the issues are detailed and treated fairly. The author has absorbed the literature, identified the salient cultural and scientific problems, and offered a useful conceptual model for addressing the problem of setting limits to health care for the elderly. An unusually insightful contribution to an already large literature. College, university, and public libraries.-J.E. Allen, University of North Carolina at Chapel Hill

In his dynamic, controversial look at the priorities of American medical research and health care, Callahan contends that medicine "should give up its relentless drive to extend the life of the aged, turning its attention instead to the relief of their suffering and improvement in the quality of their physical and mental life."

In this wise and thought-provoking review of present attitudes and public policy toward aging and death, Callahan, author of Abortion: Law, Choice and Morality, etc., faults our health care system for devoting disproportionate resources and technology on extending the lives of the elderly regardless of the quality of their lives. He also warns against the social and economic consequences of the increased ratio of old people in the population. Medical care, he suggests, should be allocated based on standards of need and priorities to meet them over a ``normal life-span opportunity range,'' limiting the use of new technology to that which improves the quality of life. He also discusses the ethics of withholding artificial sustenance from the terminally ill, euthanasia and assisted suicide. ``The proper question is not whether we are succeeding in giving a longer life to the aged,'' he argues, but ``whether we are making of old age a decent and honorable time of life.'' (September 17) (c) Copyright PWxyz, LLC. All rights reserved

The bottom line here: ""We cannot continue on the present course of open-ended health care for the elderly""--resources are too scarce, the costs too great, the benefits too questionable. What limits might be set on aggressive medical care for the elderly, and what should take its place? The answers and suggestions posed here are likely to provoke discussion and debate. Callahan (Abortion: Law, Choice and Morality) offers in his first work in some years a controversial suggestion: ""using age as a specific criterion for the allocation and limitation of health care."" He proposes that by one's late 70's or early 80's, the natural end has come: ""one's life possibilities have on the whole been accomplished; one's moral obligations to those for whom one has had responsibility have been discharged; and one's death will not seem to others an offense to sense or sensibility, or tempt others to despair and rage at the finitude of human existence."" Callahan adds a stipulation that such a death not be accompanied by unbearable pain, and has thus laid out a biographical, rather than a biological, definition of a natural end-point. And it is after this end-point, he feels, that medical care should be oriented towards the relief of suffering, rather than resisting death. To support such a new approach, our understanding of aging and of medicine, and their interaction, will all have to change. Callahan believes that the primary goal of the aging ought to be to serve the young and the future by being ""moral conservators of that which has been"" and proponents for the future. At the same time, medical care should seek to improve the quality of life, rather than extend its longevity; and we should abandon medical programs that primarily benefit the elderly, pouring resources into this one small--soon to be gone--segment of the population. The natural lifespan will have to be understood as having an acceptable end boundary, rather than an enemy to be held off at all costs. Callahan is, as before, logical and persuasive; it is clear that he wants to incite discussion, rather than prove a particular set of specifics. Provocative, well-based arguments from a respected voice. Copyright ©Kirkus Reviews, used with permission.